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EJNMMI Research
Published in: EJNMMI Research 1/2017

Open Access 01-12-2017 | Original research

3D skeletal uptake of 18F sodium fluoride in PET/CT images is associated with overall survival in patients with prostate cancer

Authors: Sarah Lindgren Belal, May Sadik, Reza Kaboteh, Nezar Hasani, Olof Enqvist, Linus Svärm, Fredrik Kahl, Jane Simonsen, Mads H. Poulsen, Mattias Ohlsson, Poul F. Høilund-Carlsen, Lars Edenbrandt, Elin Trägårdh

Published in: EJNMMI Research | Issue 1/2017

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Abstract

Background

Sodium fluoride (NaF) positron emission tomography combined with computer tomography (PET/CT) has shown to be more sensitive than the whole-body bone scan in the detection of skeletal uptake due to metastases in prostate cancer. We aimed to calculate a 3D index for NaF PET/CT and investigate its correlation to the bone scan index (BSI) and overall survival (OS) in a group of patients with prostate cancer.

Methods

NaF PET/CT and bone scans were studied in 48 patients with prostate cancer. Automated segmentation of the thoracic and lumbar spines, sacrum, pelvis, ribs, scapulae, clavicles, and sternum were made in the CT images. Hotspots in the PET images were selected using both a manual and an automated method. The volume of each hotspot localized in the skeleton in the corresponding CT image was calculated. Two PET/CT indices, based on manual (manual PET index) and automatic segmenting using a threshold of SUV 15 (automated PET15 index), were calculated by dividing the sum of all hotspot volumes with the volume of all segmented bones. BSI values were obtained using a software for automated calculations.

Results

BSI, manual PET index, and automated PET15 index were all significantly associated with OS and concordance indices were 0.68, 0.69, and 0.70, respectively. The median BSI was 0.39 and patients with a BSI >0.39 had a significantly shorter median survival time than patients with a BSI <0.39 (2.3 years vs not reached after 5 years of follow-up [p = 0.01]). The median manual PET index was 0.53 and patients with a manual PET index >0.53 had a significantly shorter median survival time than patients with a manual PET index <0.53 (2.5 years vs not reached after 5 years of follow-up [p < 0.001]). The median automated PET15 index was 0.11 and patients with an automated PET15 index >0.11 had a significantly shorter median survival time than patients with an automated PET15 index <0.11 (2.3 years vs not reached after 5 years of follow-up [p < 0.001]).

Conclusions

PET/CT indices based on NaF PET/CT are correlated to BSI and significantly associated with overall survival in patients with prostate cancer.
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Metadata
Title
3D skeletal uptake of 18F sodium fluoride in PET/CT images is associated with overall survival in patients with prostate cancer
Authors
Sarah Lindgren Belal
May Sadik
Reza Kaboteh
Nezar Hasani
Olof Enqvist
Linus Svärm
Fredrik Kahl
Jane Simonsen
Mads H. Poulsen
Mattias Ohlsson
Poul F. Høilund-Carlsen
Lars Edenbrandt
Elin Trägårdh
Publication date
01-12-2017
Publisher
Springer Berlin Heidelberg
Published in
EJNMMI Research / Issue 1/2017
Electronic ISSN: 2191-219X
DOI
https://doi.org/10.1186/s13550-017-0264-5

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